IN-DEPTH: Ohio, Ky. take steps to give OD drug to recovering addicts

Apr. 8, 2013

Hamilton County syringe exchange advocate Adam Reilly looks down at a used syringe in the grass along West McMicken Street in Mohawk. The area is known to be heavily used by heroin addicts. / The Enquirer/Glenn Hartong

A woman who goes by the street name Diamond shows the needle and track marks on her right arm while her friend, a woman who gives her street name as Crybaby, left, a self-confessed former addict and prostitute, sits along West McMicken Street in Mohawk. Diamond would have died of a heroin overdose in high school had she not been revived with Narcan. The Northern Kentucky native began using heroin at a young age. / The Enquirer/Glenn Hartong.

Mason Rue, 19, of Batavia and Samantha Gabriele, 21, of Newtown are both recovering addicts. Mason nearly died of heroin overdoses twice and was revived by Narcan. They are very much in love and plan on getting married and raising her daughter together. / The Enquirer/Glenn Hartong

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Ohio could join Kentucky in enacting legislation that would make a life-saving drug available to residents at high risk for opioid overdose, whether from heroin or prescription painkillers.

Kentucky Gov. Steve Beshear is expected in July to sign a bill that will allow physicians to prescribe and pharmacists to distribute the drug naloxone so that a third party can administer it to overdose victims. The drug blocks the brain’s opioid receptors, preventing respiratory failure, and breathes new life into dying people.

In Ohio, state Sen. Eric Kearney, D-North Avondale, plans to introduce a bill in Columbus this week that would require the state’s health department to create a training program for the safe administration of naloxone and make the drug available to relatives and friends of addicts.

Kearney, the Senate minority leader, said he was moved to create the bill after reading The Enquirer’s stories about heroin and opioid addiction and after talking with Margo Spence, president and chief executive of the women’s substance abuse treatment center First Step Home in Walnut Hills.

“I did not realize how popular heroin was and how accessible and affordable it had become,” said Kearney, who had talked with a woman at First Step Home whose life had been saved by naloxone after she’d overdosed on heroin.

In Northern Kentucky, medical and business professionals advocated in Frankfort for the legislation, initially proposed in 2012 by Rep. Tom Burch, D-Jefferson County. Medical emergency personnel have long used naloxone, the generic for Narcan, to treat those who have overdosed on prescription painkillers or heroin.

Now, Northern Kentucky leaders vow to figure out how to get enough of the drug to pharmacies, get nasal naloxone kits packaged and, ultimately, provide the drug to the people who need it most.

“It is clearly defined that people are dying from opiate overdoses – whether by prescribed medications or heroin,” said Northern Kentucky public health activist Dr. Jeremy Engel. “Either way, with this medication, lives have been saved. Once your life’s been saved you have a chance to make better choices. If you’re dead, you don’t.”

Engel, a family doctor with St. Elizabeth Physicians in Bellevue, led the regional effort to get the bill passed, telling House Health and Welfare Committee members, “People are dying” due to opiate overdose and adding, “My toolbox is empty.”

Advocates who’ve worked six years to create a syringe-exchange program in Cincinnati and Hamilton County want two doses of naloxone – applied either as a nasal spray or as an injection – to be included in kits and made widely available.

Critics of expanding the ease of access to naloxone and clean drug paraphernalia say the efforts amount to condoning heroin use.

Dr. Judith Feinberg, a professor at the University of Cincinnati College of Medicine and an infectious diseases specialist, disagrees.

“It is prevention, not permission,” she said. “The data shows that (needle exchange) decreases crime and decreases drug use and reduces the number of cases of hepatitis C and HIV. We have a public health emergency because of prescription painkiller and heroin abuse.”

Under current Ohio law, naloxone, known widely by the brand name Narcan, can legally be prescribed by a physician to patients who are at risk of an overdose. The drug is used in hospital emergency departments and by emergency medical personnel, who, in Cincinnati, say they routinely use it a half dozen times a day on overdose victims.

Paramedics in Clermont County twice saved the life of 19-year-old Mason Rue with Narcan. The Batavia man overdosed on heroin first as a Batavia High School sophomore and again as a senior.

“I was told I’d been pronounced dead for 32 seconds,” Rue said during an interview at First Step Home, where he and his girlfriend, Samantha Gabriele, 21, a recovering painkiller addict, attend couple’s therapy.

Rue said he had injected a gram of heroin and taken Xanax – a prescription medication to treat anxiety disorder – and lost consciousness on his mother’s couch.

Rue said he woke up about 30 seconds after being injected to a blinding light.

“My body felt numb. Then I felt electric static in my legs. I had indescribable cramps and threw up,” Rue said. “I woke up to a living hell but am 100 percent glad I was brought back.”

In Cincinnati’s West End, the Center for Chemical Addictions Treatment (CCAT) has begun prescribing Narcan kits for people leaving treatment.

The center has given out just 10 kits so far, but some of its clients take them reluctantly because they see it as an admission they will relapse, staff says.

In Kentucky, Engel is partnering with Covington Firefighters Local 38 Vice President Greg Salmons to create a business plan through a non-profit organization that will manage the process of getting nasal naloxone kits to people in need.

Numerous stakeholders, from business and medical professionals to elected officials – all of whom are involved in the Northern Kentucky Heroin Impact and Response Workgroup – are offering help to create the process and get naloxone out in the region and statewide, Salmons said.

The Northern Kentucky Chamber of Commerce, which is part of the NKY Heroin Workgroup, saved the bill after it appeared it would not get a vote in the House on its own.

“The NKY Chamber worked tirelessly to insert language into House Bill 366 to allow nasal naloxone to be prescribed as a treatment option,” said Adam Caswell, vice president of public affairs for the chamber.

That’s what Rue is working on. His motivation is his girlfriend, Gabriele, and her 19-month-old daughter.

“I have fallen in love with them,” said Rue, who delayed plans to marry until he and Gabriele both advance in their recovery.

He is finishing his GED and plans to take college courses at UC Clermont College in Batavia.

Another woman, his aunt, who was 45 when she died of cancer in October, made Rue realize how much he had to lose and how much he had to gain.

“She told me I wasn’t just affecting myself,” he said.

“She said that while her life was being cut short, she asked me why I was giving mine up. It broke me up. I just said: ‘I’ve got lucky twice. I

must be here for a reason. And the reason can’t be to stick a needle in my arm.’” ■